Objective To analyze the associations of serum vitamin A (VA) and vitamin D (VD) levels with blood pressure in children and adolescents, and to explore the nonlinear threshold effects based on body mass index (BMI) stratification. Methods A cross-sectional study was conducted among 447 students aged 6 -17 years in Guangdong Province from May 2019 to November 2021.Height, weight, blood pressure (mean of three measurements), and body composition (bioelectrical impedance analysis) were measured.Fasting serum VA and VD levels were determined.Optimal thresholds were identified using smoothing curves and the Akaike Information Criterion (AIC).BMI-stratified piecewise regression models were constructed to analyze the associations with adjustment for age, sex, and percent body fat (PBF). Results Overall multiple linear regression showed that the linear associations of VA and VD with systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not significant after adjustment for BMI and PBF(P>0.05).In the normal-BMI group, VD exhibited a J-shaped association with SBP with an inflection point at 27.60 ng/mL; VD was positively associated with SBP above this threshold (β=2.07, P=0.003).VA was positively associated with SBP when VA>0.30 mg/L (β=0.21, P=0.006) and positively associated with DBP when VA<0.29 mg/L (β=1.34, P=0.012),exhibiting a dual pattern.In the underweight group, when VA exceeds 0.28 mg/L, it showed a significant positive correlation with DBP (β=0.45, P<0.001).No significant association was observed in the overweight/obesity group. Conclusion The associations of serum VA and VD with blood pressure in children and adolescents exhibit complex nonlinear threshold characteristics, and these effects may be dependent on individual BMI status.
Key words
blood pressure /
vitamin A /
vitamin D /
body mass index /
threshold effect
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